Build-A-Birth: Are Epidurals a Necessity?

What better place to start our investigations than one of the most common birth practices in US hospitals — the epidural.

Many women today plan for their birth to take place in a hospital, and of those women, most of them plan to receive an epidural for management of pain. It’s kind of the assumption that a birthing woman will want relief from pain, and that a pharmacological method is the best kind of pain management. But is this true? Let’s see what the evidence suggests. We’ll start with one very fundamental assumption.

Assumption #1: Pain Management is a “necessity” in labor and birth.

I don’t know how many times I’ve heard women say, regarding labor and birth, “why should I suffer if there’s a way to avoid it?” The assumption is that if it’s available, any woman (in her right mind) would accept pharmacological relief for labor pain. Since epidurals are available in most every developed country in the world, if this assumption were correct, it would logically follow that those other countries have a similar attitude toward pain management in labor. So do they?

According to Marsden Wagner’s Born in the USA: How a Broken Maternity System Must Be Fixed to Put Women and Children First, a woman’s culture strongly influences her attitude toward pain, both in what kind of pain she expects and how much she feels is tolerable. In countries such as the Netherlands and Japan, women accept labor pain rather than view it as something to be numbed, and the rate of epidural use in both countries is much lower than in the US. So why do American women get epidurals so frequently? According to Wagner, the way a woman views pain during labor and birth are strongly shaped by how her obstetrician views pain. He states:

“The two great evils in a doctor’s world are pain and death, and they see it as their job to fight them at all costs. The physiological fact that pain is an essential component of a normal labor, that it is necessary for the release of hormones that control the progress of labor, is either not understood by most American obstetricians or simply ignored.”

So, part of the American pregnant woman’s mindset is influenced by how doctors, specifically obstetricians, view the role of pain in labor and birth. But surely doctors aren’t 100% to blame. Think of all the birth stories you’ve ever heard. How many of them emphasized the pain of birth, or the fear? If you’re anything like me, a large portion probably did. So, the attitudes of other women also play a part in our perception of labor pain. And what about the media? If I based my perception of birth on “A Baby Story” alone, I would probably think that birth was always chaotic, scary, and horrendously painful. And it’s not just reality TV — depictions of labor and birth in dramas and sitcoms are also pretty one-sided. Shows like this litter the airwaves, and it would be silly to think that we are beyond their influence.

It’s been thoroughly established that birth hurts. Aside from the fortunate few who experience “orgasmic birth,” most women experience some amount of pain when giving birth. But, unlike most pain we experience in our lives, the pain of birth does not indicate injury. It is “pain with a purpose.” To embrace that idea has the power to increase a woman’s confidence while at the same time reducing her anxiety and fear, which in turn can reduce the amount of pain she experiences. This is demonstrated by the testimonies of women who have had drug-free births, especially those who have chosen to give birth at home, away from even the possibility of pharmacological pain management.

I think the evidence for this assumption suggests that epidurals are not so much a necessity as they are a luxury. A shift in a woman’s perspective can strongly influence her birth experience, as is shown in other countries where epidurals are available but less commonly used than in the United States.